Provider First Line Business Practice Location Address:
5940 LOSEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89081-6591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-639-9002
Provider Business Practice Location Address Fax Number:
702-639-1632
Provider Enumeration Date:
12/29/2015